REVISED PROPOSED REGULATION OF THE STATE BOARD OF NURSING LCB File No. R091-04 June 11, 2004 EXPLANATION Matter in italics is new; matter in brackets [omitted material] is material to be omitted. AUTHORITY: 1 and 3-14, NRS 632.120; 2, NRS 632.120 and 632.237. A REGULATION relating to nursing; defining the term in the process of obtaining accreditation ; revising provisions regarding the authority of an advanced practitioner of nursing to write prescriptions; authorizing a licensed practical nurse to administer steroids intravenously; revising provisions regarding the accreditation of programs of nursing in this State; revising provisions regarding programs of nursing in this State; revising provisions regarding the survey of programs of nursing; and providing other matters properly relating thereto. Section 1. Chapter 632 of NAC is hereby amended by adding thereto a new section to read as follows: As used in chapter 632 of NRS, the term in the process of obtaining accreditation means an approved school of practical nursing or an approved school of professional nursing that has applied for accreditation from a nationally recognized association or an agency authorized by law to accredit such schools which has been approved by the Board. Sec. 2. NAC 632.257 is hereby amended to read as follows: 632.257 1. An applicant for a certificate of recognition as an advanced practitioner of nursing will be authorized to issue written prescriptions for controlled substances, poisons, dangerous drugs and devices only if he: (a) Is authorized to do so by the Board; --1--
(b) Submits an application for authority to issue written prescriptions for controlled substances, poisons, dangerous drugs or devices to the Board; and (c) Has successfully completed: (1) A program that complies with the requirements set forth in paragraph (a) of subsection 1 of NAC 632.260 and includes an advanced course in pharmacotherapeutics; or (2) A program of academic study that: (I) Is approved by the Board; (II) Consists of at least 2 semester credits or an equivalent number of quarter credits in advanced pharmacotherapeutics; and (III) Is completed within the 2 years immediately preceding the date the application is submitted to the Board. 2. In addition to the information contained in the application for a certificate of recognition as an advanced practitioner of nursing, [the] an applicant who completes, before June 1, 2005, a program designed to prepare an advanced practitioner of nursing and who does not hold a master s degree with a major in nursing or a related health field approved by the Board must, in his application for authority to write a prescription for controlled substances, poisons, dangerous drugs and devices [must include: (a) Documentation], include documentation of 1,000 hours of active practice in the immediately preceding 2 years as an advanced practitioner of nursing under a collaborating physician. The documentation must consist of a signed statement from the collaborating physician indicating to the Board that the applicant is competent to prescribe those drugs listed in his protocols. --2--
[(b) If the applicant has prescribed controlled substances, poisons, dangerous drugs or devices in another state within the 2 years immediately preceding the application to write prescriptions in this state, a list of the controlled substances, poisons, dangerous drugs or devices he had authority to prescribe and any disciplinary action taken against him.] 3. Except as otherwise provided in subsection 4, if an advanced practitioner of nursing who is authorized to prescribe certain controlled substances, poisons, dangerous drugs and devices changes his medical specialty, he must submit an application to the Board [, which includes documentation of 1,000 hours of active practice in the new medical specialty as an advanced practitioner of nursing under a collaborating physician,] for authority to prescribe those controlled substances, poisons, dangerous drugs and devices which are currently within the standard of medical practice in that specialty. In addition to the information contained in an application submitted pursuant to this subsection, an advanced practitioner of nursing who completes, before June 1, 2005, a program designed to prepare an advanced practitioner of nursing and who does not hold a master s degree with a major in nursing or a related health field approved by the Board, must include in his application documentation of 1,000 hours of active practice in the new medical specialty as an advanced practitioner of nursing under a collaborating physician. 4. An advanced practitioner of nursing who: (a) Is authorized to prescribe certain controlled substances, poisons, dangerous drugs and devices; and (b) Changes his medical specialty to a medical specialty that is substantially similar to his former medical specialty, --3--
is not required to submit to the Board the application required pursuant to subsection 3 if the Board has authorized him to prescribe controlled substances, poisons, dangerous drugs and devices in the practice of his former medical specialty. Sec. 3. NAC 632.450 is hereby amended to read as follows: 632.450 A licensed practical nurse who has at least 1 year of experience in nursing after receiving his initial license, who has completed a course in intravenous therapy approved by the Board pursuant to NAC 632.242, and who acts pursuant to a written order of a physician and under the immediate supervision of a physician, physician assistant or registered nurse may: 1. Start peripheral intravenous therapy using devices which act like needles and are not longer than 3 inches; 2. Introduce one or more solutions of electrolytes, nutrients or vitamins; 3. Piggyback solutions of electrolytes, nutrients and vitamins; 4. Administer antibiotics, steroids or histamine H2 receptor antagonists by adding a solution by piggyback; 5. Administer fluid from a container which is properly labeled and contains antibiotics, steroids or histamine H2 receptor antagonists that were added by a pharmacist or a registered nurse designated by the pharmacist; 6. Flush locks with normal saline or dextrose 5 percent in water; 7. Except as otherwise provided in subsection 8, administer fluid by continuous or intermittent infusion through a peripheral device which uses a mechanism to control the flow; 8. Administer fluid to a patient with a temporary central venous catheter by continuous or intermittent infusion through a peripheral device which uses an electronic mechanism to control the flow; --4--
9. Discontinue peripheral intravenous catheters which are not longer than 3 inches; and 10. Change a central venous catheter dressing. Sec. 4. NAC 632.455 is hereby amended to read as follows: 632.455 A licensed practical nurse may not administer intravenously: 1. Any drug other than an antibiotic, steroid or histamine H2 receptor antagonist; 2. Any drug which is under investigation by the United States Food and Drug Administration, is an experimental drug or is being used in an experimental method; 3. Any antineoplastic medications; 4. Colloid therapy, including hyperalimentation; or 5. Any medication administered by intravenous push. Sec. 5. NAC 632.605 is hereby amended to read as follows: 632.605 1. A university or college which wishes to establish a program of nursing in this state must submit an application to the Board. The Board will prescribe the form for the application. 2. The administrator of the program shall submit to the Board, at least 6 months before the program is offered, a statement of intent which must include: (a) Proof that the program is approved by the system of universities or community colleges of the state in which it is accredited; (b) [The reasons for establishing the program of nursing; (c)] The results of a survey which demonstrates the need for the program of nursing; [(d)] (c) The type of program which will be offered; [(e)] (d) The name and status of the accreditation of the institution offering the program; [(f)] (e) The relationship of the program of nursing to that institution; --5--
[(g)] (f) Evidence of budgetary support; [(h)] (g) The projected enrollment; [(i)] (h) Evidence that a sufficient number of qualified members of the faculty are available to conduct the program; [(j)] (i) A description of the proposed clinical facilities to be used; [(k)] (j) The resources available at the site of the program; [(l)] (k) The proposed schedule for beginning the program; and [(m)] (l) Any additional information requested by the Board. Sec. 6. NAC 632.620 is hereby amended to read as follows: 632.620 1. [The Board will not grant provisional approval to a program of nursing offered by a university or college unless students have been admitted to the program. If the Board does not grant provisional approval to the program, the university or college may request a hearing before the Board. 2.] If the Board grants provisional approval to a program of nursing offered by a university or college, the administrator of the program shall submit a report concerning the program to the Board every 6 months. [3.] 2. A self-evaluation report demonstrating compliance with the standards for nursing education approved by the Board must be submitted by the administrator of the program to the Board within 6 months after graduation of the first class. [4. The Board will visit the site of the program after the graduation of the first class of students.] Sec. 7. NAC 632.645 is hereby amended to read as follows: --6--
632.645 1. A program of nursing must have sufficient resources and facilities to prepare the students in accordance with the philosophy and objectives of the program and the policies of the institution offering the program. 2. Facilities must include: (a) Offices for administrative, instructional and clerical personnel; (b) Classrooms, laboratories, conference rooms and equipment for use for various teaching methods; (c) Library resources which are appropriate and available to students for the purpose of the program with consideration given to their usefulness and scope and the currency of their books and periodicals; and (d) Clinical facilities sufficient to achieve the objectives of the program, including written criteria for the selection of those facilities approved by the Board. 3. Written contractual agreements must be entered into by the administrator of the program and all agencies and institutions which provide educational experiences for students of that program. Sec. 8. NAC 632.665 is hereby amended to read as follows: 632.665 1. The administrator of a program of nursing shall: (a) Devote a sufficient amount of time to administer the program; (b) Prepare and administer the budget for the program; and (c) Notify the Board of any substantial change in the program or its administration. 2. The instructional duties of the administrator of a program of nursing must be consistent with the scope of his administrative duties. --7--
[3. The administrator of a program of nursing is responsible for persons who provide support services for that program, including persons who provide secretarial or audiovisual services or instruction relating to manual skills performed in a laboratory.] Sec. 9. NAC 632.670 is hereby amended to read as follows: 632.670 [1.] A member of the faculty of a program of nursing must be licensed to practice as a registered nurse in this state. [2. Each member of the faculty who is hired after September 1, 1995, must hold a master s degree with a major in nursing and have completed training which is related to his area of teaching.] Sec. 10. NAC 632.675 is hereby amended to read as follows: 632.675 1. A program of nursing must have a competent and stable faculty. The majority of the members of the faculty must be full-time employees. 2. Of the faculty who are hired after the effective date of this regulation: (a) At least 75 percent of the members must hold at least a master s degree with a major in nursing and have completed training which is related to the area of teaching of the member; and (b) Except as otherwise provided in subsection 3, the remainder of such members, if any, must hold at least: (1) A master s degree with a major in nursing; (2) A master s degree in a field related to nursing; or (3) A graduate degree from an accredited school of nursing as defined in NRS 632.011. 3. The Executive Director of the Board may, for good cause shown, waive the requirements of paragraph (b) of subsection 2. --8--
4. The members of the faculty shall develop and evaluate the curriculum and the educational practices of the program. [2.] 5. Except as otherwise provided in this subsection, in courses relating to the care of patients, there must be at least one member of the faculty for every eight students. The Executive Director of the Board may, upon a showing of good cause, waive the requirement. [3.] 6. A program of nursing that uses the personnel of a clinical facility as preceptors to instruct the clinical experience of students must require: (a) Each preceptor to have clinical expertise and to have demonstrated competence in the [medical] specialty of the students whom he will instruct; (b) Each preceptor to be approved by the faculty of the program of nursing; (c) The faculty of the program of nursing to provide to each preceptor an orientation concerning the roles and responsibilities of students, members of the faculty and preceptors; and (d) The faculty of the program of nursing to develop written objectives and provide a copy of those objectives to each preceptor, before the preceptor begins his instruction of the students. [4.] 7. In addition to the requirements set forth in subsection [3,] 6, a program of nursing that uses the personnel of a clinical facility as preceptors to instruct the clinical experience of students: (a) Must ensure that each preceptor is assigned to instruct not more than two students at the same time; (b) Must designate a member of the faculty to serve as a liaison between the preceptor and each student who participates in the clinical experience; (c) [Must not use a preceptor to teach the initial acquisition of basic nursing skills; --9--
(d)] Must require that each preceptor be present in the clinical facility and available to the students at all times when the students provide nursing services to patients; and [(e)] (d) May use a preceptor to reinforce basic nursing skills or to teach nursing skills which build on the basic nursing skills that the students have acquired. [5.] 8. There must be at least one qualified administrator for each department or division of the program. [6.] 9. If a university or college offers a program of nursing for more than one level of preparation, there must be one person who is responsible for each such level. Sec. 11. NAC 632.685 is hereby amended to read as follows: 632.685 1. The curriculum of a program of nursing must [reflect] : (a) Reflect the philosophy and objectives of the program [. 2. Credits awarded for courses which are related to nursing and courses which are not related to nursing must be] ; and (b) Be based on a rationale that ensures sufficient preparation for the safe and effective practice of nursing. 2. Credits for courses must be awarded appropriately. Sec. 12. NAC 632.690 is hereby amended to read as follows: 632.690 1. A program of nursing which [trains] educates practical nurses must include instruction in the following areas of nursing: (a) [Surgery;] Care provided to persons who require surgery; (b) Care provided to persons who do not require surgery; (c) Maternal and child health; and (d) Mental health. --10--
2. A program of nursing which [trains] educates registered nurses must include instruction relating to: (a) Basic [knowledge] principles of biology, psychology and sociology; and (b) The theory and practice of nursing including, [but not limited to,] without limitation, the attainment, intervention and maintenance of physical and mental health and the prevention of illness for persons and groups of persons. 3. Courses relating to theory and clinical experience must be taught in a concurrent or sequential manner. 4. The administrator of a program of nursing shall prepare and maintain records of the evaluation of the curriculum by members of the faculty and students enrolled in the program. Sec. 13. NAC 632.703 is hereby amended to read as follows: 632.703 1. A program of nursing which conducts a portion of its program in Nevada shall submit to the Board a report, on a form provided by the Board, which includes: (a) Proof of its current accreditation or approval by the state in which the program originates or by any applicable national accreditation body; [and] (b) All correspondence received within the preceding year from the accrediting body or bodies [.] ; and (c) Evidence satisfactory to the Board that the portion of the program conducted in Nevada is conducted in compliance with the provisions of chapter 632 of NRS and this chapter relating to conducting a program of nursing. 2. The administrator of the program of nursing shall: (a) Notify the Board in writing of any adverse action taken against the program by the accrediting body or bodies within 30 days after the action is taken; and --11--
(b) Complete and submit an annual school report on forms provided by the Board. 3. The Board may conduct a complete visit to the program of nursing to determine its eligibility for approval at any time, or may accept all or part of the survey and findings on accreditation from the state in which the program originates. Sec. 14. NAC 632.708 is hereby amended to read as follows: 632.708 In lieu of a survey of a program of nursing required by NAC 632.706, the Board may deem a program of nursing as being surveyed if [the] : 1. The program has received accreditation from a nationally recognized association that accredits schools of nursing, as approved by the Board [, within the 4 years immediately preceding the date the Board deems the program as being surveyed.] ; and 2. The Board issues a written statement which sets forth the reasons the Board deemed the program as being surveyed. --12--